Careless Cuts

Ganga Maya Shahi lay fully awake, while her friends slept soundly on the sunlit
grass beside her. This was in June of 2013 and Ganga, from Surkhet, looked anxious;
she was to leave the hospital the next day after having undergone an operation on
her uterus, which had been troubling her for over a decade. A screening camp had
been held a few months ago by the Sushma Koirala Memorial Trust, which had asked
her to visit another camp at one of the Primary Healthcare Centres in the area. But
although the procedure appeared to have solved her age-old uterine problem, she
didnt feel entirely well. They didnt allow us to stay after the second day of
surgery, Ganga recalls. I was too weak to travel, and there were no hotels around.
We had to stay under a tree for a few days more until I regained the strength to
walk home.
Ganga represents the many problems plaguing the ongoing Uterine Prolapse (UP)
programme in Nepal. Despite its noble objective of relieving women who are
suffering from the pain of prolapse, lack of regulatory and monitoring mechanisms
means the programme has become far too commercialised of late, placing many
women in unnecessary peril and offering little in the way of post-op care.
It was primarily after the Peoples Movement of 2006 that health was recognised as
one of the fundamental rights of the Nepali people, part of which was reproductive
rights. Uterine prolapse, a condition wherein a womans uterus or womb is found to
be sagging or slipping out of its normal position, was also recognised as an illness
that called for urgent intervention. A 2006 research conducted by the UNFPA
showed that an estimated 600,000 women suffer from UP, out of which 200,000
require surgery, which is generally only opted for when ones uterine issues have
advanced to the final stage. So, five years ago, a separate unit was established at
the Family Health Division (FHD) of the Department of Health Sciences, intended to
oversee a nation-wide UP programme, where the government would provide
surgical care to prolapse patients. Government records show that 48,096 UP cases
have been treated so far, with a majority of them undergoing operations.
The initiative has no doubt helped a lot of women return to good health. However,
rampant commercialisation of the same has raised serious concerns regarding the
quality of post-op and follow-up care that is available to patients. For instance, at
the PHC in Surkhet where Ganga Shahi was treated, a government team had
conducted an inspection. Theyd found that in the three days that the camp had
ran, over 30 women had been operated uponby a single doctor, in a single day.
The maximum number of operations that could be done in a day would be four or
five at most...Its terrifying to think of them cramming so many women into their
schedule, says Dr Aruna Uprety, an activist who has been advocating against
medical malpractices.
Many experts also believe that these health camps recommend surgery to women
who dont actually need it. Given that practitioners look to earn anything from Rs
12,000 to 15,000, depending on the locations, from the government for each
surgery, the temptation to earn as much as possible becomes evident.

After visiting a number of other hospitals and health camps besides the one in
Surkhet, the government team had prepared a draft report titled Status and Issues
of Uterine Prolapse Programme for the fiscal year 2012/2013. The report, based on
field visits, interviews with patients, and data analyses, called for an immediate
intervention with regards to the malpractices that had been observed, and the
practically non-existent post-operative and follow-up services for patients. It also
said that the operating sites were much too small to accommodate all of the
operated cases, and that some patients had been relegated to convalescing in the
open, while five or six others were crowded onto the same mattress. Essentially, the
health camps were deemed neither prepared nor equipped to handle the surgeries,
or any emergency scenarios, given the absence of a referral mechanism.
Further light is thrown on the problem by a 2011 survey, which clearly attests to the
poor quality of UP surgeries conducted in health camps across the country.
According to the surveyPerception, Experience and Health Outcome of Women
Who Had Undergone Uterine Prolapse Surgery in Doti district of Nepalalmost 40
percent of the sufferers of UP in Doti, who sought treatment at a camp, have been
experiencing post-operative complications, including discomfort while sitting down,
bleeding, chest pain, and difficulty in walking, among others. The survey was
conducted among 121 women by the Family Health Division, the South Asian
Institute for Policy Analysis and Leadership and the WHO.
Dr Uprety says the currently prevalent trend of operating in health camps should be
stopped altogether. Operations need to be conducted in proper institutional setups, she says. We want the government to stop the surgery programme, until it
can be monitored well enough to ensure that women do not continue to be
butchered like animals. She adds that a major chunk of the funds for the
programme shouldve been allocated to post-operative care and follow-up
counselling and treatment. Families need to be counselled well on what to do after
the patient is taken homehow much rest they need, what food they should
consume, that sort of thing.
The government, meanwhile, has acknowledged the carelessness that has marred
the efficacy of the programme, and Dr Kiran Regmi, director of the FHD, says that
they are presently reviewing the guidelines of the UP programme and hope to have
a better model up and working soon. Until then, however, more and more women
continue to visit these camps, only to be lulled into a false sense of security,
sometimes leaving with more problems than they had when they arrived.
Published in The Kathmandu Post, 2014-03-01